Other Vaccination Considerations

Adverse Effects Adverse effects are seen regularly in patients given mitoxantrone (see Table 26-3). Patients often experience bluish discoloration of the sclera and the urine for 24 hours after infusion.46 Transient leukopenia and neutropenia are common with a nadir 10 to 14 days after the infusion. Patients should avoid exposure to infectious individuals during this time.46 Patients taking mitoxantrone should not receive live virus vaccines other vaccines should be held for 4 to 6 weeks after a mitoxantrone dose.46 Amenorrhea, caused by a direct toxic effect on the ovary, may be permanent, an important consideration because the MS population includes women of childbearing potential.27... 

The protective efficacy of Engerix B has been demonstrated in a number of trials, in the context of infants, children and adults. Seroprotection rates (measured as serum anti-hepatitis B antibody titres above a value of 10 mlU ml-1) of over 95 per cent were usually recorded. The product was found to be generally well tolerated. The most frequently reported adverse effects were local reactions at the injection sites, fever, headache and dizziness. Special consideration to risk benefit ratio should be given to MS patients, as exacerbations of this condition have been (rarely) reported following administration of hepatitis B and other vaccines. Engerix B is manufactured and marketed by GlaxoSmithKline. 

Billions of doses of vaccines were safely administered over the last century to millions of infants, children, and adults [1,4], Vaccine-associated adverse events were nevertheless identified in a minority of patients. Many of the adverse events were directly related to the vaccine others as in the case of MMR have not been substantiated with data but still cause considerable public unease [1], One documented case is that of vaccination with a formalin-inactivated respiratory syncytial virus (RSV) that, when given prophylactically, caused enhanced disease after exposure to the virus and resulted in the death of some children [1,4,5], An increased incidence of Guillain-Barre syndrome appeared to be associated with a swine flu vaccine that was tested in humans in the late 1970s [1,6]. Guillain-Barre syndrome has also been associated with other vaccines including those for polio, measles, and hepatitis B [6]. 

Although a humoral immune response is the primaiy protection against most viral and some bacterial diseases, protective defense against other pathogens such as HIV, Plasmodium and Mycobacterium tuberculosis requires a cytotoxic response mediated by CD8+ T-cells (CTL response). Since the introduction of the vaccination concept by Jenner almost 200 yeats ago, only few vaccines have been developed that are able to induce a CTL response. These vaccines are usually attenuated live vaccines that are accompanied by certain risks and are not readily available for most pathogens. The immense appeal of DNA vaccines can be attributed to a considerable part to the fact that they are able to induce... 

An additional consideration that may influence the protocol used is the desired duration of subsequent expression of the gene product. In most cases of genetic disease, long-term expression of the inserted gene would be required. In other instances (e.g. some forms of cancer therapy or the use of gene therapy to deliver a DNA-based vaccine), short-term expression of the gene introduced would be sufficient/desirable. 

A wide range of pharmaceutical substances are derived from animal sources (Table 1.10). Many are protein-based and detailed description of products such as insulin and other polypeptide hormones, antibody preparations, vaccines, enzymes, etc., have been deferred to subsequent chapters. (Many of the therapeutic proteins are now also produced by recombinant DNA technology. Considerable overlap would have been generated had a product obtained by direct extraction from native sources been discussed here, with further discussion of a version of the same product produced by recombinant DNA technology at a later stage.) Non-proteinaceous pharmaceuticals originally derived from animal sources include steroid (sex) hormones, corticosteroids and prostaglandins. A limited discussion of these substances is presented below, as they will not be discussed in subsequent chapters. Most of these substances are now prepared synthetically. 

A common lesson distilled from experience with voucher programs is the importance of careful consideration of targeting voucher eligibility criteria and phase-out conditions. The relatively small value of a vaccine voucher makes this scenario unlikely. Nonetheless, it is necessary to prevent or at least not exacerbate a situation in which people could lose more in vouchers and other benefits than they would gain by increasing their income or savings (Bradford and Shaviro 2000). 

Carbon nanotubes are unique materials with specific properties [42]. There is a considerable application potential for using nanotubes in the biomedical field. However, when such materials are considered for application in biomedical implants, transport of medicines and vaccines or as biosensors, their biocompatibility needs to be established. Other carbon materials show remarkable long-term biocompatibility and biological action for use as medical devices. Preliminary data on biocompatibility of nanotubes and other novel nanostructured materials demonstrate that we have to pay attention to their possible adverse effects when then-biomedical applications are considered. 

Almost all of the biopharmaceuticals available today, other than vaccines, are proteins or peptides. Of considerable importance among this array of products are monoclonal antibodies. These magic bullets became a reality with... 

There are a number of examples of the development of plants for pharmaceutical protein production including antibodies, vaccines, and other bioactive proteins (Daniell et al., 2001 Daniell, 2006 Ma et al., 2005a, b, c Twyman et al., 2003) as well as consideration of the issues surrounding regulatory issues of the use of transgenic plants for pharmaceutical protein applications (Ma et al., 2005b Sparrow et al., 2007 Spok, 2007). 

The registration of medicinal products is governed by relative values which cannot be clearly defined or limited, for example by ethical considerations and the endeavour to ensure the best possible quality and safety of pharmaceuticals. What is possible and achievable, may soon become a standard by which subsequent products will be measured. This leads to continuous and desirable improvements, but since there is no limit, very costly and undesirable extremes may be another consequence. According to today s standards, the most successful and beneficial pharmaceutical products, such as the vaccinia virus vaccine, live poliovirus vaccine and other live vaccines, would probably not be registrable for a wide-spread use in humans. 

State laws on mandatory vaccination vary considerably in the legal implications for nurses and administrators. Typically, it is the individual who falls within the class required to be vaccinated who bears the legal burden. Thus, laws that condition the attendance in public schools on first having a vaccination for a particular disease typically bar the individual from school if there is no vaccination. Other laws may impose a criminal fine or other criminal penalty on the individual who refuses to be vaccinated. In some cases, state laws may allow for the isolation or quarantine of individuals who refuse to be vaccinated. Some state laws may require that health professionals, including nurses, inform certain patients about vaccination requirements and might possibly require some action, such as notification to a local or state health department, if the vaccination is refused. Nurses will need to check with the legal counsel of their hospital for the specific requirements in their state. 

---